"Dilemma"

Dr Logan Earthski works with adolescents and their families.During the course of treating one adolescent male, the parents, Mr. and Mrs. Hawk, expressed frustration with their son Tony's lack of involvement with sports. The Hawks detailed how Tony enjoyed team sports in the past, but has not enjoyed participating due to anxiety and constantly comparing himself to others.In order to bond and connect with the family, Dr. Earthski explained from his experience with teens, some male teens function better with individual sports.Dr. Earthski disclosed that he grew up skateboarding and taught lessons forseveral years.A few of the children and adolescents he taught fit the description of Tony.In those cases, the adolescent tried soccer or baseball, but did not really like it because they felt too anxious and overly competitive. When it came toindividual sports, like skateboarding, teens that became involved with individual sports usually showed a decrease in anxiety and an increase in self-confidence.However, sometimes, when adolescents first show up at the skatepark, they may experience a similar level of anxiety and heightened self-awareness that Dr. Earthski helped remediate during his coaching sessions.Dr. Earthski alsorevealed that he worked with one particular teenager who became very anxious and experienced episodes of panic related to going to the skate park.That adolescent did not think he was good and was weary of other kids watching and judging him.Dr. Earthski gave him some coaching on anxiety reduction techniques and worked through those negative, anxiety-provoking emotions.Further, he did very well at skateboarding once he conquered his symptoms of anxiety and panic. The teenager's self-confidence grew as he performed better at the skate park. Based on Dr. Earthski's revelations, the parents seemed reassured.

Prior to the next session, Dr Earthski received a voicemail message from Mrs. Hawk asking if he could coach Tony on skateboarding

After thinking about this request, Dr. Earthski calls you for a consultation. Dr Earthski puts forward the following concerns:

1. Is coaching a teenager-patient on anxiety-related issues in context of skateboarding lessons definitively on a dual relationship?
2. What if the coaching is time-limited, informed consent is given, and this activity is viewed as the exception rather than the rule? ("Time-limited" means between one and six sessions, depending on his response to treatment.)
3. Can time-limited skateboard coaching be incorporated as part of an in-vivo anxiety reduction technique and billed as therapy services?
4. Would Dr. Earthski's malpractice insurance likely cover this activity?
5. What would happen if the teen-patient injured himself as part of coaching?
6. Dr. Earthski asks about the use of self-disclosure. What feedback might you give to Dr. Earthski about the use of self-disclosure. What feedback might you give to Dr. Earthski about what he disclosed about himself?
7. Given everything you know about the case, what is/are the final recommendation(s) about this scenario?

In the mental health field a dual relationship is a situation that exist in between a therapist, mental health professional and a client as it will happen to Dr. Earthski

Avoiding the dual relationship into the treatment plan is the best decision, because otherwise there may come a situation where he might misuse their power and influence which can exploit the clients for their own benefits.

Gladding(2002) described several moral principles that form the basis of making ethical decisions, nonmaleficence, beneficence, justice, fidelity and veracity.

From these principles flow the ethics and standards of practice of mental health associations. Their purpose is to establish relatively clear expectations for professional behavior particularly following the ethical standards regarding dual relationships that Dr. Earthski should be doing with Tony, encouraging coaching will impact and determine a connection between DR. Earthski'sresponsibility to the client.I have identified in this context that Dr Logan Earthski will be violating the ethical code of harming the client and his family if he goes ahead in taking the skateboarding coaching where it would be foreseeable and unacceptable and can turn to be a conflict between the Ethical laws and regulations , Dr Logan Earthski should be taking reasonable steps to solve this matter by working with consideration of the fact with the General Principles and the Ethical Standards of Ethical Code in which under no circumstances he must not bear in mind not to violate human rights. Dr Logan would likely be subject to harming Tony and Tony's parents Mr and Mrs Hawk, it is not appropriate for informal resolution under ethical standard Informal resolution of Ethical violations.

The principle A beneficence and Nonmaleficence will come to act with Dr Logan if he works and takes care to do no harm. Dr Logan should seek to safeguard the welfare and wellbeing of the patient and the rights of those with whom he interacts professionally. Conflicts could occur if Tony gets injured and concerns of the family could resolve conflicts later on because If Tony during the training gets injured this will affect the relationship and the lives of others and the reputation of DR Logan. Dr Logan can help by using his influence by giving mental health treatment but not coaching to Tony.

Under solicitation of Clients on another's care the medical professionals do not solicit patients or do knowingly offer professional services to those under the care

So Dr Logan cannot offer coaching services to Tony as he is a minor and mentally strained (AACC-2014) . It would encourage other clients if he does so.

Dr Logan should remain focused on how to best serve his client by providing therapy for his anxieties in order to contribute to decisions that may affect later the well being of the client by drawing on the perspectives, values and beliefs of the counseling profession and other disciplines.The recent revision of the ACA Code of Ethics changed the ethical guidelines related to dual relationships. Careful review of the specific ethics code of language addressing dual relationships is imperative in order to navigate this prevalent ethical issue. Though the 1995 code offered guidance on the topic of dual relationships, the ( 2005 ACA Code of Ethics) provides more explicit guidelines about which dual relationships are ethically non acceptable and which are strictly prohibited.

The primary rationale for the argument to abstain from all dual relationships is that therapists may misuse their power to influence and exploit clients for their own benefit and to the clients' detriment (Bersoff, 1999; Borys, 1992; Herlihy & Corey, 1992; Koocher & Keith-Spiegel, 1998; Pope, 1991; Pope & Vasquez, 1998

"Legal Issues"

The legal issues in this case is thatDr. Earthski should be planning to take he into consideration the welfare of the client, by giving effective treatment and avoiding harm and exploitation.Dr. Earthski has to consider several factors in making this decision for the client for coaching which will include the length and nature of the counseling relationship, client diagnoses or issues.. The possibility that the client might want to return toDr. Earthski for counseling in the future.

In closing, we reiterate that the subject of dual relationships is a complicated topic that requires all counselors to examine the potential risks and benefits of entering these relationships. We hope that the issues and recommendations reviewed in this article will help more counselors to respond to potential dual relationships in ways that produce therapeutic outcomes with their clients.

After discovering the vignette and by researching the issue I have come to understand that when coaching a teenage patient (Tony) on anxiety related issues on skateboarding lessons which can be considered a dual relationship as the therapist is decided on taking on a role outside of his profession.

1 For me coaching a teenager patient on anxiety related issues will be in the context of skateboarding lessons which can be considered a dual relationship. A dual relationship occurs when a therapist takes on multiple roles or relationships with a client outside of the therapeutic relationship. In this case the therapist is acting as both a therapist and addressing the client to anxiety related issues and a skateboarding coach which blurs the boundaries of the therapeutic relationship and can potentially create conflicting interest.

2 Even if the therapist is having the coaching time limited and informed consent is given it is still considered a dual relationship and can potentially present ethical concerns. Most of the time the time limited nature and informed consent addresses some concerns but dual relationships are generally discouraged in therapy due to the potential harm they can cause to the therapeutic process and the clients well being. The therapist should prioritize maintaining a certain level of clear and professional therapeutic relationship to ensure the best possible outcomes for the client.

3 The time limited skateboard coaching cannot be billed as therapy services unless it is conducted within the scope of therapy and is specially addressed at the anxiety symptoms of the patient. In order for the therapy services to be billed , they must meet the criteria of therapeutic interventions which are aimed at improving mental health. If the skateboarding coaching is not directly related to the therapeutic goals and is not guided by the principles of evidence based therapeutic practice then it cannot be considered therapy and billed as such.

4. It is unlikely that Dr. Earthski's malpractice insurance would cover this activity as it falls |outside the scope of therapy and which entitles potential risks for the client. Malpractice insurance typically covers services provided which is within the standard scope of practice for a therapist. In this case since the skateboarding coaching is not within the scope of the therapy and presents potential risks that are due to the physical nature of the activity it is unlikely that the insurance would cover any claims or incidents that are related to this activity.

5. If Tony is injured himself during the coaching, Dr Earthski may be held liable for any negligence or lack of proper supervision. Since the therapist is taking over the function of a skateboarding teaching they have a duty to care to ensure the protection of the client throughout the coaching classes, if the therapist fails to offer the right education, supervision or takes movements that result in the injury he'll be held legally chargeable for the harm prompted to the client.|

6 The remarks to Dr Earthski regarding the self disclosure might rely on the specifics of what he disclosed. Generally, the therapist should be careful about self disclosure in relation to the remedy as it may doubtlessly shift the point far from the purchaser's needs and therapeutic goals and onto the therapist. The self disclosure has to be used while it is therapeutically useful and serves as a clean purpose in helping the client. The therapist should carefully consider the impact and potential consequences of their self disclosure.Ensuring it does not overshadow or detract from the client's progress or therapeutic work.

7 The final recommendations would be to cease the dual relationship and focus

solely on the therapy within the professional boundaries. It is important to prioritize the wellbeing and safety of the patient and to adhere to ethical guidelines and standards of practice. Continuing the dual relations will put the therapeutic process at a risk and can potentially harm the client. It is also advisable to refer the patient to a skateboarding coach or instructor who can provide the appropriate guidance and support in that realm, while the therapist continues to focus on addressing the patient's anxiety related issues in therapy.

" Ethical Code"

The ethical code than I have planned to apply in this scenario is

Collegiality in Christian counseling which is a call to relationship in preparing for teaching and supervision of christian counseling. They have to receive adequate training and experience in teaching methods before they deliver these services. They have to maintain and enhance their skills through continued clinical training practice, advanced training and continuation of education whereasDr. Earthski is only qualified, educated only in his profession he cannot exploit or educate Tony parents about giving the coaching which would appear of exploitation, harmful dual relationship.Dr. Earthski For me coaching a teenager patient on anxiety related issues will be in the context of skateboarding lessons which can be considered a dual relationship. A dual relationship occurs when a therapist takes on multiple roles or relationships with a client outside of the therapeutic relationship. In this case the therapist is acting as both a therapist and addressing the client to anxiety related issues and a skateboarding coach which blurs the boundaries of the therapeutic relationship and can potentially create conflicting interest.

The challenge of dual relationships targets the boundaries of workers assisting people in their homes and communities, it is performed in the ambiguous settings of community where the work is often aimed at linking people in the ordinary and natural surroundings of the therapeutic center and in his locality.

A dual relationship is defined as one in which a service giver assumes a second role with a service recipient, for example becoming both support worker and neighbor (Kagle & Giebelhausen,1994).

Justification of the selected code would be

Dr. Earthski inorder to help people and improve health and well being he must establish and maintain a therapeutic relationship. He must be aware of their feelings and motivations in order to ensure that the relationship remains ethical and therapeutic, having boundaries will ensure safety and keep the therapeutic relationship profession for exampleDr. Earthski is also a coach; the occurrences in the field can interfere with the client.

The American Psychological Association(APA) has recognized that harm and exploitation can result from some forms of dual relationship. The ethical principle requires psychologists to avoid impairing their own professional judgment or increasing the risk of exploitation of his clients through unacceptable dual relationships as he did in the previous clients.

Principle 3 states that " Do not exploit" steps have to be taken to reduce the relationships that are demonstrated and recognized as crucial. It is to avoid clients using to meet their own needs, social, sexual, professional or financial, because dual relationships that are exploited. It is to help the clients and to make adaptive arrangements to meet needs of ethical behavior and of perpetuating harmful and exploitive behaviors.

To conclude, Dr. Earthski should reiterate that the subject of dual relationships is a complicated topic which requires all counselors to examine the risks and benefits of entering into dual relationships. We hope that the issues and recommendations reviewed here will help to respond to potential dual relationships in ways that procedure therapeutic outcomes with their clients.

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